Copy this page onto a blank document. Write in your answers to each question. SAVE
your answers. Most of this information can go directly onto a provider organization application.

Participating in this exercise will help prepare you in the process of getting
a service dog. Some of these questions will be asked by the source of your dog. Having the answers ready will
make the process go more smoothly. Also, you will begin to think about the changes and adjustments you will need to
make in having a service dog.

Sample Application

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